What Are Isolation Gowns?

Isolation gown purpose is to help protect your frontline caregivers and staff from infectious droplets, fluid penetration and solids, and help prevent the transfer of micro-organisms to vulnerable residents.

There are two main categories of isolation gowns intended for healthcare purposes: surgical and non-surgical.

Know the Level of Protection Standards

The FDA recognizes the consensus standard American National Standards Institute/Association of the Advancement of Medical Instrumentation (ANSI/AAMI) PB70:2003, “Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities.”

There are four levels under the standard:¹

• Level 3: Moderate risk, to be used, for example, during arterial blood draw, inserting an intravenous (IV) line, in the emergency room, or for trauma cases
• Level 4: High risk, to be used, for example, during long, fluid intense procedures, surgery, when pathogen resistance is needed or infectious diseases are suspected (non-airborne)

For Senior Living, Level 1 basic fluid resistance is generally desirable to combat the spread of COVID-19. Having a gown with a higher level rating isn’t essential as there isn’t extensive risk of blood or other bodily fluids being transferred. For more advanced fluid-resistance needs, consider a surgical gown with a higher-level rating.

What’s on the Product Label is More Important Than the Product Name

For these purposes, we use the term isolation gown. But you should pay less attention to a product name (e.g., isolation gown, nursing gown, procedural gown, etc.) and more attention to function, intended use and what level of protection is provided. The label or packaging will call this out.

During the COVID-19 pandemic, primary objectives are to protect frontline Senior Living staff from the spread of COVID-19 and to protect the accidental transfer of COVID-19 to other residents and staff. Level 1 basic fluid resistance in a non-surgical isolation gown is most likely sufficient. Having a surgical gown with a higher level rating isn’t essential as there isn’t extensive risk of blood or other bodily fluids being transferred.

Evaluate Purpose, Material and Clean vs. Sterile When Choosing Isolation Gowns for Healthcare Settings

The Centers for Disease Control suggests that you consider three things when choosing gowns for healthcare settings.²

Clean vs. Sterile

Clean isolation gowns are used for isolation, while sterile gowns are used for invasive procedures like inserting a central line. For COVID-19, a clean isolation gown works well.

How Easy is an Isolation Gown to Put On and Remove?

The ease or difficulty with which a gown is put on and removed may affect its effectiveness and the potential for self-contamination, especially during the doffing of a contaminated gown.

How Many Different Sizes and Fits Do You Need?

In a non-COVID-19 world, each staff member would have a gown that fit them perfectly. During the current PPE shortage, that’s not realistic in many parts of the country, and a universal size may be the only option. In such cases it’s still critical to make sure that the gown allows the wearer enough freedom of movement to perform their required tasks while still providing as much coverage of their skin and clothing as possible.

Isolation Gown FAQ:

What are isolation gowns?

There are two main categories of isolation gowns intended for healthcare purposes: surgical and non-surgical. 

What are isolation gowns made of?

Typically cotton or a synthetic material like polyester (reusable isolation gowns), or polyethylene or polypropylene (disposable gowns). 

What are PPE gowns used for?

Clean isolation gowns are used for isolation, while sterile gowns are used for invasive procedures like inserting a central line.

References

How to Choose Lifting Slings

First, identify how many patient lift slings slings your healthcare setting needs. While there isn’t one right answer to this question and the quantity will depend greatly on the patient population in a building, below is a general starting point. These per-lift recommendations will change based on the acuity level of patients and body type.

Sit-To-Stand Lifts:

Sit-to-stand lifts help patients who have some mobility, but need assistance rising from a sitting position. Sit-to-stand lifts allow caregivers to comfortably and safely assist mobility patients with sitting and standing. Below are a few sit to stand lift sling considerations:

Standing Slings: 2 medium and 1 large

Standing slings are ideal for patients who can bear half or more of their own weight and have sufficient head and neck control. These types of sit-to-stand lift slings can take patients from a seated to standing position.

Transport Slings: 1 medium and 1 large

Transport slings provide back support up to a patient’s shoulder area and underneath their thighs. Transport sit-to-stand lift slings can be used for seated transports, such as bed to chair or in room transport.

What Are Specialty Patient Slings?

Keep in mind that you may have patients who, based on weight, shape or specific health needs, require other sizes or sling types (hygiene, walking, gait training, repositioning, etc.)

A few examples of patient-specific slings include:

• Bariatric Sling
• Repositioning Sling
• Harness

What materials are slings made from?

Patient lift slings can also be customized to meet specific needs through their sling material. Common lifting lift material includes:

• Poly. Poly slings are the standard lift sling material and are strong and durable.
• Mesh. Mesh slings are commonly used for bathing, as they dry and let go of water easily.
• Padded. Padded Sit-to-Stand sling material offers added comfort for patients.

Lifting Slings Chart: Multi-Brand Compatible Slings

Direct Supply offers a variety of sling and lift solutions for your healthcare setting. Discover our multi-brand compatible sling selection and learn more about this versatile offering in this Multi Brand Sling Vlog.

Direct Supply’s multi-brand slings have passed compatibility testing and are appropriate to use with leading brands of lift equipment. The lifting slings compatibility charts below contain our Direct Supply multi brand compatible sling models, material and size options:

Floor Lift Slings Chart:

Sit-to-Stand Lift Slings Chart:

Shop the full collection of Direct Supply’s multi-brand slings to standardize and save on slings in your healthcare setting.

A best practice is to assess the needs of each individual patient to determine the lift and sling mix you should purchase. Some benefits of purchasing patient-specific slings include:

How Do I Determine What Sling My Resident Needs?

While fit and comfort are important assessment factors when choosing the correct sling, there are other essential considerations to take into account. The determination of the correct sling model and size must be done by a licensed clinician. That designated licensed clinician should:

1. Assess the resident and determine that the resident actually requires a lift/assist device
2. Determine the correct lift/assist device and sling based on the resident assessment and the manufacturer’s instructions. Follow manufacturer’s recommendations to determine the appropriate sling based on the desired function.
3. Document the specific recommended lift/assist device (make, model and weight capacity) and sling (make, model and size – including any specific attachment instructions). Remember, slings can be made of mesh, breathable fabric, nylon, quilted, padded and may have parts that can be plastic or metal. Be specific.

How Do I Ensure Proper Usage?

Having the proper equipment is an excellent start, but making sure your staff and residents know how to use them is absolutely essential. Be sure to follow any and all manufacturer instructions and safety compliance instructions. Additionally, consider these tips:

How to Select a Wheelchair

• Determine the right type of wheelchair
• Size your wheelchair properly
• Select the appropriate features

To a healthy person, sitting in an awkward position is uncomfortable, but for seniors it can be a danger to their health. The first step to finding the correct wheelchair is to select the type of wheelchair your resident is best suited for – a decision largely dependent on the individual resident and how the wheelchair will be used.

Standard Wheelchairs
Standard wheelchairs are the most common type of wheelchair, providing durable construction and high weight capacities. They are more durable than lightweight wheelchairs and generally less expensive, but not as adjustable.

Heavy Duty Wheelchairs
Heavy Duty wheelchairs offer a large-capacity reinforced frame for supreme durability. 

Reclining Wheelchairs or Tilt Wheelchairs
Reclining wheelchairs and tilt wheelchairs provide pressure redistribution for resident-specific support or relief for a range of conditions. These chairs are often part of an individualized care plan based on clinical assessments.

Bariatric Wheelchairs
Bariatric Wheelchairs are the strongest type of wheelchairs, with reinforced steel at all weight-bearing points help provide additional strength. These chairs are available in wider sizes and with higher weight capacities than Heavy-Duty wheelchairs.

How to Choose a Wheelchair Size

The most important measurements you need to take are seat width, back height, seat depth and seat-to-floor height. By providing a wheelchair with the proper dimensions in these four areas, you will avoid some of the most common and dangerous positioning concerns. Measuring all fields will help ensure optimal comfort and safety.

How to Calculate a Resident’s Seat Depth

1. Measure resident’s rear of buttocks to back of knee
2. Subtract 2½”
3. Add thickness of back cushion (if a cushion is used)

How to Determine Seat-to-Floor Height

1. If resident is under 5′5″ tall, use a Hemi size wheelchair with a 17½” seat height
2. If resident is between 5′5″ and 6′2″, use an Adult size wheelchair with a 19½” to 20½” seat height
3. If resident is over 6′2″ tall, use a Tall size wheelchair with a 21½” seat height

Back Height

Seat-to-Floor Height

Wheelchair Features FAQ

Discover the right features to address your resident’s risk factors, activity level and acuity.

What are the different types of wheelchairs?

There are many different types of patient wheelchairs: transport wheelchairs, lightweight wheelchairs, standard wheelchairs, heavy-duty wheelchairs, bariatric wheelchairs and reclining wheelchairs. Depending on your wheelchair, learn how to select the best wheelchair cushions.

What are my options for wheelchair armrests?
Full-length armrests provide more support for easier ingress and egress while desk-length options allow the chair to fit easily under most desks or tables. Adjustable and flipback armrests can be raised and lowered to better suit the resident.

What are front riggings, and which does my resident need?
Front riggings are optional front-mounted hardware that provides a place for residents to put their feet. Swingaway footrests support the residents’ feet while they are in the chair and rotate out of the way for easier transfers. Elevating legrests support the legs with comfortable calf pads and allow angle-of-elevation adjustment. Articulating legrests are similar to elevating options, but they extend during elevation for enhanced comfort.

What are my upholstery options, and how are they different?
Vinyl is easier to clean and more durable, while nylon is lighter weight and more breathable.

What does “dual axle” mean?
Dual-axle capabilities mean that your wheelchair can transform from standard to hemi height. Hemi height is about 2″ lower than standard seating. This allows the user to more easily self-propel and is also beneficial for residents shorter than 5′ tall.

What is Skin Breakdown?

Skin becomes more fragile as we age. With less of a protective barrier, this increases skin injury risk factors. Skin can also become damaged from being in the same position for a long period of time. When the skin is deprived of blood flow, it can lead to pressure injuries, such as pressure ulcers and pressure sores. This is known as skin breakdown.

What Causes Skin Breakdown in the Elderly?

Prior to COVID-19, Senior Living residents may have exercised by walking to the dining area for a meal. Instead, social distancing required meals and other activities to take place in their rooms. As a result of long-term confinement and minimal opportunities for ambulation, residents may have been sitting or lying down more frequently than before the pandemic. This reduced activity may cause joints, muscles and skin to weaken, placing seniors at greater risk for skin breakdown.

Bariatric residents and patients with incontinence have an increased risk of developing skin breakdown due to inadequate blood supply from immobility and difficulty in keeping skin clean.

What Causes Skin Breakdown in Hospital Patients?

During a hospital stay, patients’ skin may be impacted by long bed stays and sitting in a single position for too long. Long staying patients may be susceptible to bedsores or pressure ulcers. Items in the hospital environment, such as unfamiliar soap and cleaning products may more easily dry out patients skin.

Nursing Interventions to Prevent Skin Breakdown

Identifying Limited Mobility

One way staff can help address skin breakdown in elderly residents and hospital patients is by identifying an individual’s mobility and positioning needs while he or she is seated, and leveraging equipment that may aid with skin breakdown prevention. Consider abnormal posture issues, such as posterior pelvic tilt or pelvic rotation due to the frequency of being supine or seated.

Strategies for Wound Care and a Skin Care Plan

To prevent skin breakdown and reduce pressure risks, identify a wound and skin care prevention plan for your staff.  Beyond healthcare equipment, your healthcare professionals staff can follow preventive skin breakdown strategies with:

• Skin cleansers and barrier creams.

Ensure that you are avoiding care products that dry out skin. Consider quality skin cleansers, moisturizers and barrier creams to prevent skin breakdown. 

• Proper nutrition and hydration

Senior Living residents and hospital patients who aren’t moving around, may not also be eating and drinking sufficient nutritional amounts, which could increase the risk of skin breakdown. Consider enhancing nutritional diets and fluid intakes in relation to skin condition. Learn how to promote hydration in your healthcare environment.

As you evaluate these particular products and skin breakdown preventive measures in your healthcare setting, here are some questions you can ask yourself:

Are you using an advanced pressure management surface under residents and patients with existing pressure injuries?
Previously healed pressure wounds place residents at a higher risk for skin breakdown, so pressure wound prevention is a top priority. Consider using air cushions with cells that are pumped up to help “float” the pelvic region. Other air cushions have closed cells that fill into compartments within the construction of the cushion.

Are you using a high quality pressure redistributing mattress with a breathable cover?
If so, be sure the resident is comfortable and not sitting “through” the mattress.

Does the mattress help offload pressure from the heels, such as having softer foam, or does it slope to float the heels?
A sloped heel section will help redistribute the pressure away from the heels and move to the resident’s calves. The calves are a bit meatier and better able to spread out the pressure.

Does the mattress have features like die-cuts, open-cell breathable foam and a breathable 4-way stretch cover?
All of those features will help create a cooler microclimate between the resident and the mattress.

Do your assistive devices allow independent residents to turn and reposition themselves while in bed?
Where applicable, residents could be offered an assistive device to help them safely move or reposition on their own in bed. This could be an assist bar, a trapeze or even a repositioning ladder.

Are slide sheets available to assist with repositioning the resident in bed?
Slide sheets are another way to reposition a high acuity resident in bed. Whenever possible, do not share slide sheets between residents. If they need to be shared, be sure to properly wash and disinfect between residents.

What Are the Biggest Factors in Choosing a Wheelchair Cushion Type?

Wheelchair cushions are not a one-size-fits-all solution for your fleet and should be suited to each patient individually. As you make this assessment, the two most important considerations are cushion shape and cushion material, each providing their own set of benefits. These different options cater to unique conditions, however, and using the wrong wheelchair cushion could lead to hazardous positioning. Choosing the best wheelchair seat cushion type can provide long term benefits for patients and can prevent and heal skin breakdown.

What Are the Different Wheelchair Cushion Shapes?

The four most popular wheelchair cushion shape types are saddle-shaped wheelchair cushions, pommel-shaped wheelchair cushions, wedge-shaped wheelchair cushions and anti-thrust wheelchair cushions.

When choosing a wheelchair seat cushion shape type, it’s important to consider a patients’ mobility and positioning needs. Do they need pain pressure relief for posture issues, such as posterior pelvic toilet or pelvic rotation? Skin breakdown can be prevented by choosing a wheelchair cushion type that comfortably positions patients. 

Anti-Thrust Wheelchair Cushions: Used to help mitigate slide for seniors and patients who are constantly moving in their wheelchairs. An anti-thrust wheelchair seat cushion prevents sliding with a high-front and low-back cushion design. 

How Can I Choose the Best Wheelchair Cushion Material?

The three most popular wheelchair cushion material types are foam, gel and air. The materials your wheelchair cushions are made of can have an impact on resident comfort and experiences. Foam wheelchair cushions, gel wheelchair cushions and air wheelchair cushions each present their own set of benefits.

• Foam Cushions for Wheelchairs: Best for maximizing immersion with a greater degree of pressure management and offloading properties.
• Gel Cushions for Wheelchairs: Best for regulating body temperatures and reducing buildup of moisture.
• Air Cushions for Wheelchairs: Best for advanced pressure management and all-day comfort with a cool and dry surface.

Wheelchair Cushion FAQ:

What are the different types of wheelchair cushion shapes?

The four most popular wheelchair cushion shape types are saddle-shaped wheelchair cushions, pommel-shaped wheelchair cushions, wedge-shaped wheelchair cushions and anti-thrust wheelchair cushions.

What are the types of wheelchair cushion material?

The materials your wheelchair cushions are made of can have an impact on resident comfort and experiences. Foam wheelchair cushions, gel wheelchair cushions and air wheelchair cushions each present their own set of benefits.

What are the biggest factors in choosing a wheelchair cushion type?

The overarching two most important considerations are cushion shape and cushion material, each providing their own set of benefits.

The Benefits of Choosing the Best Wheelchair Seat Cushion Type

Knowing how to choose the best wheelchair seat cushions for patients in your healthcare setting can create comfortable wheelchair experiences and prevent pressure sores and skin breakdown. Refer to our blog on using equipment to prevent skin breakdown to see how mattresses and other assistive devices can also increase your patients’ quality of care.

Aging in Assisted Living is not new. What’s changed?

It’s actually a combination of several leading factors, including consumer demand, expanded capabilities and changes due to healthcare reform. Seniors are waiting longer than ever to move into Senior Living, and those who live in Senior Living want to stay in their current apartments longer. Today, the average age of a resident in Assisted Living is 87. In 2000 it was 80.

Advances in medical care are helping people live longer with more chronic conditions. When you look at the research, the first incidences of cardiovascular disease, heart failure and stroke significantly increase over the age of 80. This may mean Assisted Living residents are taking more medications, need more transfer and mobility assistance, and have an increased risk of frailty.

How are providers responding?

When working with Assisted Living providers who want to expand their services, I often ask them what they are able and willing to provide. This is an important question with two distinct parts. The ability to provide additional or new services is largely based on state licensure and regulations. Many states limit the type of care and assistance a resident may receive in Assisted Living.

Once a provider understands what they are able to provide, we’ll discuss what they are willing to provide. Adding additional services may change how their business operates, affect how many staff and the type of staff needed, change policies and documentation, and possibly require adding equipment. Many providers will add services like on-site visits by a physician or nurse practitioner, the ability to meet with a dietitian or social worker, or expanded home health services with on-site nursing care and physical therapy.

What’s one of the more interesting changes you’ve seen?

As a nurse, I’m always interested in how nurses are adapting to the care environments they practice in. High acuity nursing in Assisted Living can be challenging due to the regulatory environment that often limits how much nursing care can be provided.

One of the interesting changes I’ve seen is adapting a community health model to Assisted Living. Viewing the Assisted Living facility as a community and applying principles of community health nursing can encourage a more coordinated approach to serving a resident’s needs within the boundaries of regulation and licensing. The community is better aligned to support the individual through screening programs, risk reduction interventions, health education, environmental modifications and physical activity.

What products are Assisted Living providers adding to meet these changes?

We are seeing Assisted Living providers select products that help improve outcomes and meet their residents’ health and wellness goals. Sometimes it’s as simple as a scale placed in an apartment so the resident can record a daily weight as part of managing heart failure. Or it may be equipment that helps with staff efficiency, like a vital signs monitor on a wheeled stand that can take blood pressure, temperature and oxygen saturation. We’ve also seen providers increasing opportunities for activity with exercise equipment, like stepper machines with virtual reality games and four-in-one exercise machines that offer varying resistance levels.

In the last few years, we’ve seen providers add more mobility aids and transfer devices to help increase safety. Many providers are realizing the risk of staff and resident injuries increases when residents require more assistance. In addition, senior mobility aids and walking devices can help residents maintain their independence. There are also newer types of transfer and lifting devices that often work better for senior mobility needs and living environments in Assisted Living.

1. Evaluate Your Current Resident Safety Program

Creating a safe, welcoming Assisted Living care environment for your seniors and staff starts with investing in a safe resident handling program for your community. Using an assessment guide is a great place to start thinking about how you can introduce, implement and maintain a culture of safety. It can help you understand the current Assisted Living landscape and evaluate how well your community is equipped to handle high acuity. Working through a step-by-step guide that suggests products and next steps can make it easier to implement a program.

Ask yourself a few key questions to help you determine how your community stacks up:

• Do I have an established process for routinely evaluating senior mobility and transfer ability?
• Have I seen increases in staff injuries or workers’ compensation costs?
• Is my community equipped with the right mobility aids and transfer devices to improve these experiences and also improve staff and senior safety?

Assisted Living residents who actively participate in their healthcare are more likely to adapt behaviors that promote and maintain senior safety. Increase resident engagement by reviewing assessment results, providing information on fall prevention and showing exactly what happens during the use of a mechanical lift.

By working directly with your residents and staff, you can help create safer Assisted Living care environments for everyone.